Psychophysiological comparisons of three kinds of headache subjects during and between headache states: analysis of post-stress adaptation periods

Painful Stimulation of the Temple Induces Nausea, Headache and Extracranial Vasodilation in Migraine Sufferers

To determine whether painful stimulation of the temple would induce nausea, ice was applied to the temple for 30 s, three times at 4-min intervals in 23 migraine sufferers and 22 age- and sex-matched controls. On one occasion, the ice was applied in the presence of residual motion sickness induced by optokinetic stimulation. On another occasion, the ice application was not preceded by optokinetic stimulation (the baseline condition). In the baseline condition, nausea had developed in migraine sufferers but not controls by the third application of ice. In the presence of residual motion sickness, each painful stimulus intensified nausea and headache in migraine sufferers whereas symptoms were minimal in controls. Changes in frontotemporal pulse amplitude were monitored with photoelectric pulse transducers. The extracranial blood vessels dilated in migraine sufferers but not controls before the first application of ice in the baseline condition, presumably due to anticipatory anxiety. In contrast, the ice application did not provoke extra-cranial vasodilation in either group after optokinetic stimulation. The findings show that susceptibility to nausea and stress-induced extracranial vascular hyper-reactivity are associated with the migraine predisposition. They also suggest that head pain might intensify gastrointestinal disturbances during attacks of migraine.

Passive Paradigm Single-Tone Elicited ERPs in Tension-Type Headaches and Migraine

The active 'oddball' event-related potential (ERP) P3 is elongated or reduced in migraine and tension-type headaches, indicating a deficit of active attention in these primary headaches. It is then reasonable to study the passive attention function in these headaches through the technology of passive paradigm singletone elicited ERPs. We invited 32 patients suffering from chronic tension-type headache (CTTH), 17 from frequent episodic tension-type headache (FETH) and 32 from interictal migraine without aura, as well as 28 healthy subjects to undergo passive paradigm single-tone ERPs. There were no statistically significant differences when the mean latencies and amplitudes of N1, P2, N2 or the mean latencies of P3 of the four groups were considered. In contrast, the P3 amplitudes were significantly reduced in the patient groups when compared with healthy controls. However, no further significant difference was found between patient groups when considering P3 amplitude. Our study demonstrated a deficit of passive attention in CTTH, FETH and migraine, but could not separate these headache types in this regard. The reduced P3 in patients might be due to the head pain experienced.

Comparison of the Effects of Induced Muscle Tension Variations on Task Performance in Headache-prone and Non-headache Subjects

Tension (muscle contraction) headache is often associated with high task demands, and relaxation is frequently recommended during daily work activities in many treatment programs. The effect of relaxation on concurrent task performance is assumed to be beneficial, or at worst to have no effect, but this assumption is seldom made explicit. This paper presents results from two experiments which have examined the effects of muscle tension and relaxation on concurrent task performance, in headache-prone and non-headache groups. Results indicated that induced frontalis relaxation did not generally result in optimal task performance; the performance measure affected (accuracy or reaction time) was related to the type of task being performed. Differences between the headache and non-headache subjects were especially related to interactions between task difficulty level and “optimal” level of frontalis tension. Further research is needed to clarify the aspects of performance most affected by variations in frontalis tension and the appropriateness of attempting to relax the frontalis muscle in task situations.

Behavioural treatment programme contributes to normalization of contingent negative variation in children with migraine

BACKGROUND

Migraine is a disorder of central information processing which may be characterized by increased amplitudes and reduced habituation of evoked and event-related potentials. In this pilot study, special behavioural training of habituation to aversive stimuli (MIPAS-Family = Migraine Patient Seminar for Families) was developed and proven effective in children suffering from migraine without aura.

METHODS

13 children with migraine participated in the MIPAS-Family programme and 13 other children with migraine were treated with biofeedback. The influence of both treatments on abnormal cortical information processing in migraine was assessed using recordings of the contingent negative variation (CNV), an event-related slow cortical potential.

RESULTS

Both MIPAS training and biofeedback caused an equal reduction of migraine frequency and severity. However, MIPAS treatment was associated with a significant increase in iCNV habituation. Changes in the clinical course of migraine correlated positively with normalization of habituation: the greater the reduction in headache frequency, the greater the increase in CNV habituation was. These effects were not observed in the biofeedback group.

CONCLUSIONS

This study demonstrates that the specific treatment programme which was evolved from knowledge of pathogenetic mechanisms of migraine influences central information processing and leads to a clinical effect.

Control conditions in hypnotic-analgesia clinical trials: challenges and recommendations

Case studies and controlled clinical trials indicate that hypnotic analgesia can effectively reduce pain in patients with a number of different chronic pain conditions. However, because none of the studies published to date have included a credible control condition that adequately controls for expectancy effects, at this point we cannot conclude that hypnotic-analgesia treatment has a specific effect on chronic pain beyond that that might be produced by a credible placebo intervention. This paper (a) describes the types of control conditions that have been, or might be, used in clinical trials of hypnotic analgesia for chronic pain; (b) reviews their strengths and weaknesses; and (c) concludes with specific recommendations that investigators should consider when designing clinical trials of hypnotic analgesia.

Toward a rational understanding of migraine trigger factors

The typical migraine patient is exposed to a myriad of migraine triggers on a daily basis. These triggers potentially can act at various sites within the cerebral vasculature and the central nervous system to promote the development of migraine headache. The challenge to the physician is in the identification and avoidance of migraine trigger factors within patients suffering from migraine headache. Only through a rational approach to migraine trigger factors can physicians develop an appropriate treatment strategy for migraine patients.

Psychophysiological reactivity in pediatric migraine patients and healthy controls

The hypothesis that physiological responses of migraine patients are symptom-specific was evaluated in 29 children (age range 8-16 years) suffering from migraine and 10 healthy control children. The assessment included two major stress phases and a relaxation period. A standard laboratory stressor (a subtraction task) and parent-child conflict served as stressors. A total of six physiological parameters were measured: pulse amplitude at two extracranial (A. temporalis, A. supraorbitalis) and one peripheral (index finger) sites; finger temperature; heart rate; and skin-conductance level. There were no significant group differences in autonomic arousal. Moreover, extracranial and peripheral vasomotor activity was not different between groups, a finding which might be partially due to the considerable interindividual variability. The implications of the results are discussed taking into account that studying pediatric rather than adult migraine patients allows to minimize the potentially confounding impact of factors such as headache chronicity, medication, and additional nonmigraine headaches.

"Hysteria" in clinical neurology

Hysteria is an ancient word for a common clinical condition. Although it no longer appears in official diagnostic classifications, "hysteria" is used here as a generic term to cover both "somatoform" and "dissociative" disorders as these are related psychopathological states. This paper reviews the clinical features of four hysterical syndromes known to occur in a neurologist's practice, viz conversion, somatization and pain disorders, and psychogenic amnesia. The presence in the clinical history of a multiplicity of symptoms, prodromal stress, a "model" for the symptom(s), and secondary reinforcement all suggest the diagnosis, and minimise the need for extensive investigations to rule out organic disease. Psychodynamic, behavioral, psychophysiologic and genetic factors have been proffered to explain etiology. Appropriate treatment involves psychotherapeutic, behavioral and pharmacological techniques. A basic requirement is to avoid errors of commission such as multiple specialist referrals and invasive diagnostic and treatment procedures. Hysteria is a remediable condition if identified early and managed appropriately.

The physiological stress response and the role of cognitive coping in migraine patients and non-headache controls

Our study investigated physiological response specificity and cognitive coping in migrainous patients during an achievement task situation. Thirty-three migrainous subjects and thirty-two non-headache controls were subjected to 40 min of demanding cognitive tasks and 20 min of recovery during which cranial and peripheral vasomotor responses were registered as well as electrodermal and myographic activity. Subjects of both groups were randomly assigned to two experimental conditions, a so-called 'spontaneous processing condition' and the 'positive coping treatment'. In this treatment condition subjects received a short training in the conscious use of positive self-statements in stress situations. Though a specific pattern of cranial vasomotor responses in migraine subjects could be verified by group statistics, this pattern was only found in very few individuals. Reliable differences between groups could not be identified in other physiological variables either. The hypothesis that the predicted cranial vasomotor specificity in migraine subjects correlates with negative cognitive coping habits in migraine subjects best revealed in the 'spontaneous processing' condition, was not corroborated. The treatment variation regarding coping produced somewhat paradoxical effects, more relaxed and positive self-evaluation (subjective level) and more arousal (physiological level). Results are discussed for their impact on the psycho-biological model of migraine.

Abnormal extracranial vasomotor response in migraine sufferers to real-life stress

Temporal and digital pulse amplitudes, forehead temperature, heart rate, respiration rate and electrodermal activity of 37 migraine patients and 37 matched controls from a population of psychology students were recorded during three experimental sessions: adaptation, real-life stress (an examination) and experimental stress (an IQ test). Migraine sufferers showed significantly smaller pulse amplitudes of the temporal artery during the examination than the control group. No group differences were present in the other physiological measures. The findings are interpreted as indirect evidence for the symptom specificity hypothesis, which states that individuals with specific psychosomatic complaints display abnormal responses to stress in the relevant physiological system.

The impact of contextual cues on the interpretation of and response to physical symptoms: a vignette approach

This study examined the impact of two contextual cues--stress and aging--on conceptualizations of, and health care responses to, physical symptoms. Eighty-three undergraduates each read four vignettes describing a woman experiencing physical symptoms indicative of either heart attack, depression, ulcer, or flu. Subjects were randomly assigned to one of six age/stress cue combinations. Consistent with predictions, physical symptoms presented with stress cues were less likely to be attributed to acute illness and were seen as more variable. The effect was most pronounced for heart attack symptoms, which, when presented with stress cues, were also less likely (1) to be identified as a heart attack, (2) to be attributed to chronic illness, (3) to elicit recommendations to seek medical care, (4) and to be regarded as serious. The age manipulation did not exert an effect. Implications of these findings and limitations of the vignette approach are discussed.

The use of electromyography and muscle palpation in the diagnosis of tension-type headache with and without pericranial muscle involvement

The Headache Classification Committee of the International Headache Society recently issued revised diagnostic criteria for headache disorders. According to these criteria, tension-type headache may be subclassified depending upon whether pericranial muscle disorder is found. The presence or absence of pericranial muscle disorder was to be determined by palpating the muscles for tenderness or by measuring electromyographic (EMG) activity. In this study, pericranial muscles were palpated, and EMG activity was measured in 27 episodic tension-type headache patients and 32 headache-free controls. All testing was done while the subjects were in a headache-free state. Muscle tenderness was positively associated with the diagnosis of tension-type headache. Headache subjects exhibited significantly higher levels of temporal EMG activity compared to controls, but EMG data were of little use in assigning individual subjects to diagnostic groups. Measures of muscle tenderness and hyperactivity were only weakly associated. Pericranial muscle tenderness and elevated EMG activity may index different aspects of abnormal muscle function.

The application of generalizability theory to surface electromyographic measurements during psychophysiological stress testing: how many measurements are needed?

Generalizability theory is an extension of classical reliability theory that allows multiple sources of measurement error in an experimental design to be investigated simultaneously. In the present study, generalizability theory was used to evaluate measurement error in psychophysiological test procedures used to differentiate tension headache patients from normal controls based upon measures of electromyographic (EMG) responding. Thirty-three subjects who met diagnostic criteria for tension-type headache and 40 normal control subjects who rarely or never experienced headache participated in two laboratory sessions. EMG activity of head and neck muscles was recorded while subjects performed baseline, relaxation, choice reaction time, psychomotor tracking, and cold pressor tasks. Variance components were computed for an experimental design having subjects nested within experimenters and crossed with sessions and replications. Generalizability coefficients were computed for combinations of various numbers of sessions and replications. The generalizability of EMG measures was highly variable, depending on the experimental conditions in force. The largest sources of measurement error were attributed to the unique responsiveness of individual subjects under a particular set of treatment conditions. For some stress tests currently in use, data from several testing sessions may need to be averaged in order to achieve acceptable levels of generalizability. Generalizability greater than 0.80 can be expected only rarely when data are collected during a single session. In the research setting, low generalizability may account for the failure of EMG-based stress tests to differentiate tension headache patients from controls during stressful task performance. In the clinical setting, the generalizability of information derived from "stress profiling" or muscle "scanning" techniques, which depend on results obtained during a single testing session, is doubtful.

Electromyographic and affective responses of episodic tension-type headache patients and headache-free controls during stressful task performance

Thirty-four subjects meeting diagnostic criteria for episodic tension-type headache and 42 who rarely experienced headaches participated in two laboratory sessions in which cephalic electromyographic (EMG) activity, electrodermal activity, heart rate, and finger temperature were recorded. Subjects performed relaxation, choice reaction time, psychomotor tracking, voluntary muscle contraction, and cold pressor tasks. Headache subjects showed significantly greater EMG activity than controls during baseline and stressful task performance. During relaxation, both groups reduced EMG activity from baseline levels, and there was no significant difference in EMG level between the groups during relaxation. Headache subjects reported higher levels of subjective anxiety, depression, anger, and stress than controls. Headache subjects also reported higher levels of pain than controls, and headache subjects reported greater pain during stressful task performance relative to baseline and recovery periods.

Psychophysiological mechanisms of chronic headaches: investigation using pain induction and pain reduction procedures

Psychophysiological investigations of tension headaches and migraines have produced inconsistent and inconclusive findings. The study reported here aimed to further explore headache mechanisms by repeating earlier research with two main variations. The first pertained to recording and analytic procedures: a different approach was taken to measuring and interpreting cephalic vascular activity. The second was in the experimental conditions used: pain levels were manipulated so that the psychophysiology of headaches could be studied under conditions of pain increasing and decreasing. The findings provided no support for the role of muscle tension as a headache mechanism. Tentative support was obtained for vascular models of headaches. Headaches were associated with distension of the superficial temporal artery between pressure pulses. The data suggested that local vasomotor activity might play a role in dilating the temporal artery but that the effect seemed driven by elevated blood pressure and heart rate.

Electromyographic biofeedback training for tension headache in the elderly: a prospective study

This study evaluated the effects of a 12-session frontal electromyographic biofeedback training regimen on the headache activity of eight tension headache sufferers aged 62 and older. The biofeedback sessions were slightly modified for a geriatric population, essentially to increase comprehension and retention of rationale and instructions. Post-treatment assessment at three months revealed significant decreases in overall headache activity (50% or greater) in 50% of the subjects, and moderate improvement (35%-45%) in three of the remaining four subjects. Significant clinical and/or statistical pre-post differences were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of biofeedback training for tension headache in an elderly population and, unlike previous retrospective studies, suggests that such therapy may be an effective intervention in the treatment of tension headaches in the elderly.

Electromyographic recordings of low back pain subjects and non-pain controls in six different positions: effect of pain levels

Surface electromyographic (EMG) activity recordings of bilateral paraspinal muscle tension were measured twice on 20 non-pain controls and on 46 low back pain subjects (21 individuals with intervertebral disk disorders and 25 subjects with unspecified musculoskeletal backache) during 6 positions: standing, bending from the waist, rising, sitting with back unsupported, sitting with back supported, and prone. Back pain subjects were measured during both low pain and high pain states. Results revealed a non-significant trend for all subjects, regardless of diagnosis, to have higher paraspinal muscle tension levels on the second (or high pain) assessment. A significant diagnosis by position interaction was observed which was similar to the interaction in our previous study which employed only a single measurement session. Analysis of simple main effects revealed this to be due to control subjects during the standing position having lower EMG levels than the back pain groups, and intervertebral disk disorder subjects having higher EMG levels than the other groups during the supported sitting position. As in our previous study, diagnosis was found to be a clinically significant factor, in that controls had much fewer clinically abnormal readings than back pain patients. The lack of a significant effect for pain state is congruent with findings in the headache literature. The importance of clearly defined diagnostic categories in low back pain research and the utility of measuring subjects in various positions is discussed, as are possible explanations for lack of significant pain state findings.

Effect of movement and position on muscle activity in tension headache sufferers during and between headaches

This paper presents the results of two studies. In the first, 20 tension headache subjects were evaluated in both a headache and non-headache state on bilateral trapezius and unilateral frontalis electromyographic activity during six positions: standing, bending from the waist, rising, sitting with back unsupported, sitting with back supported, and prone. Results indicated no effect of headache state on either measure. In a second study, 11 of the tension headache sufferers in Study One and 11 age-matched controls were compared on the same measures (controls were assessed two times, with a one-week duration separating evaluations). Results indicated a diagnosis by position interaction, with post-hoc tests revealing the muscle activity of tension headache sufferers to be considerably higher during the prone position than that of non-headache controls. Non-significant trends were found when examining the data for clinically significant abnormalities (90% of the headache sufferers were found to have significant clinical abnormalities).

Temporal stability of paraspinal electromyographic recordings in low back pain and non-pain subjects

This paper presents the results of two studies in which bilateral surface EMG recordings of paraspinal muscle tension were measured in 29 lower back pain and 20 normal subjects in 6 different positions (standing, bending from the waist, rising, sitting with back supported, sitting unsupported, prone) on two occasions, and a comparison of the data from both studies. Measures were highly reliable when examined using analysis of variance procedures. Statistically significant reliability coefficients were obtained when the absolute values of the measures were examined, although in some instances less than 20% of the variance was explained. When examined as relative [percent change from baseline (prone) condition] values, differences between the two groups were observed: the normals were statistically more reliable than lower back pain subjects during every condition. Implications for clinical work and both basic and applied research are discussed.

Headache versus nonheadache state: a study of electrophysiological and affective changes during muscle contraction headaches

Seventeen carefully screened muscle contraction headache sufferers were tested in both the headache and the nonheadache state. At baseline, forehead and trapezius EMG were higher, whereas finger temperature and finger blood volume were lower in the headache than the nonheadache state. At a borderline level, physiological reactivity was greater during the headache than the nonheadache state in response to a reaction-time stressor. During the headache state, subjects also reported themselves to be more anxious, depressed, and angry than they were in the nonheadache state and said they felt themselves to be more hassled by external stressors and less able to cope with, prevent, and control their headaches. The findings are consistent with the notion that shoulder/neck tension and emotional arousal contribute to tension headaches. Evidence is less clear for the contribution of vasomotor factors and general physiological reactivity.

EMG in common migraine: changes in absolute and proportional EMG levels during real-life stress

The absolute and proportional EMG levels of the frontal, temporal, and corrugator muscles of 37 migraine patients and 37 matched controls were recorded during three experimental sessions: adaptation and real-life and experimental stress, both of long duration. Migraine patients did not show significantly different absolute EMG levels but had higher proportional EMG levels of the corrugator muscle than controls in each session. Migraine patients did not have different facial muscle responses to stress, and the two experimental groups reacted similarly to real-life and experimental stress. No relation was found between muscle activity and reported headache within 24 h after real-life stress. Increased EMG activity due to stress does not seem to be a significant cause of headache in common migraine as defined in this study, but rather a response to pain. Migraine patients with headache during stress showed lower muscle tension than patients without headache.

Psychophysiologic response patterns in migraine before and after temperature biofeedback. Prediction of treatment outcome

Psychophysiologic response patterns were studied in female migraine patients during headache-free periods (n = 16) and in controls (n = 8). Cardiovascular variables studied were heart rate (HR) and temporal artery pulse wave amplitudes (PWA). Phasic responses to 80-dB, 1000-Hz tones, each lasting 2 sec and sounded at irregular intervals, were studied within a habituation laboratory design. In addition, electromyographic (EMG) levels from the frontal muscles and hand temperature were measured. HR responses were less pronounced and PWA reduction more pronounced in migraine patients than in controls. There were no differences between migraine patients and controls in habituation pattern. Migraine patients showed lower hand temperature and higher EMG levels than controls. Migraine patients were treated with eight temperature biofeedback sessions and were evaluated clinically and psychophysiologically during and 2 months after treatment. Clinical follow-up evaluation was done 2 years after treatment. An average reduction in headache frequency of 66% was reported. A relationship between HR and PWA response pattern before treatment and treatment outcome was found. Migraine patient reporting most pronounced clinical improvement showed a "normalization" of the PWA response pattern after treatment.